Pensions_Ministry

"Pensions Ministry (Great Britain). - Before the World War the Admiralty and the War Office were responsible in the United Kingdom for the award and payment of service and disability pensions. The commissioners of the Royal Hospital, Chelsea, acted for the War Office in respect of pensions to warrant officers, N.C.O.'s and men. Pensions to privates and N.C.O.'s were paid quarterly by the regimental paymaster, those to officers and warrant officers by the paymaster-general. In the financial year 1913-4 there were in round numbers 60,000 service and 25,000 disability pensions for the army (men), and for the navy 33,000 and 7,700 respectively. The total annual cost to the State was £3,695,000. In the subsequent changes the disability pensioners were transferred to the new organizations, the service pensions remaining unaffected.

The first war alteration was made in Sept. 1914. A Central Army Pension Issue Office was set up and weekly instead of quarterly payment of pensions was authorized. Next, by the War Pensions Act 1915, the local war pensions committees were set up, under a statutory central committee " for the purpose of administering supplementary assistance in case of hardship and providing for the after-care of disabled officers and men." These committees were appointed under schemes of local authorities, more than half the membership being nominated by these authorities. The Ministry of Pensions was subsequently set up by the Act of Dec. 1916. This transferred to a minister responsible to Parliament the powers and duties of the Admiralty, the War Office, and the Chelsea Commissioners " in respect of the administration and payment of pensions and grants to officers and men, to their widows, children and dependents and to persons in the nursing service of the Naval and Military forces," the administration of service pensions being left with the service departments. It was provided that the powers and duties of the statutory committee above referred to should be continued under the control of the minister, who should communicate through it with the local committee. This arrangement proved unworkable, and in 1917 a new War Pensions Act dissolved the statutory committee and transferred its powers to the minister. A pensions appeal tribunal was set up. In 1919 a further Act conferred a statutory title to pension, subject to the conditions of the royal warrant. Previously it had been, in theory, only an act of grace. Independent statutory appeal tribunals were also appointed.

In the Ministry of Health Act (1919) provision was made for the transfer by order in council of " all or any of the powers and duties of the Ministry of Pensions with respect to the health of disabled officers and men after they have left the service" to the Minister of Health, at a date " not earlier than one year or later than three years after the termination of the present war." A further addition to the series of the Pension Acts was made in 1920, when an Act was passed providing that after the termination of the present war fresh cases were not to be transferred to the Ministry of Pensions, but were to remain, as in pre-war days, under the care of the War Office and Admiralty respectively, to whom the Air Ministry must now be added. Finally under the War Pensions bill of 1921, it was proposed that the large proportion of temporary awards should be converted into permanent awards, a right of appeal being granted to the pensioner. The period was to be within four years of his discharge from the service or after the first award of a pension to him. The administrative functions of the local war pensions committees were also to be limited and the numbers of these bodies reduced.

Award of Pensions. - Pension finance, generously revised at the outbreak of the World War, was reorganized from time to time in accordance with the changing type of recruits and the rise in the cost of living. The scales of 1917 and 1918 were again considered in 1919 by a select committee of the newly elected House of Commons, which settled the rates governing payments till 1923. The principle of payment is that of compensation for disablement attributable to or aggravated by war service. " Disablement " is assessed by purely medical opinion, in terms of a percentage reduction from the standard of a normal healthy man. The pension is on a flat rate graded from 20% to loo %; below 20% only a lump sum is awarded payable usually in weekly allowances. Pensions are in the first instance awarded temporarily-usually for 12 months-and remain temporary till the disability has reached its final and stationary condition, when they are made permanent. The patient is subject to periodical medical examination during this time, and at each " board " his disability is reassessed for the next period. In addition the principle was laid down in 1917 that no account was to be taken of the earnings of disabled men. The " alternative pension " was also provided whereby a man might obtain a pension (within certain limits) running up to his full pre-war earnings, which by the Warrant of 1919 were further loaded up by 60% on account of the increased cost of living. Widows, also, may choose alternative pensions (husband's earnings plus 60%), and this right has been exercised in a large number of cases. The new pension scales were not to be subject to revision before April 1923.

The following figures may be quoted from the Warrant of 1919: (1) Totally disabled (privates): Man .

(+ attendance allowance up Man and wife. Man, wife and one child. Man, wife and two children For each additional child .

(2) Widows: Childless 20s. (+ 6s. 8d. if aged 40).

With one child. ... 36s. 8d.

With two children. .. 44s. 2d.

For each additional child. ... 6s. Although the assessment of disablement is a purely medical matter, the question of entitlement (i.e. whether due to war service) is decided by medical and lay opinion combined. The claimant has an appeal against the assessment of a medical board to a medical appeal tribunal; he may similarly appeal against refusal of entitlement to one of eleven statutory pensions appeal tribunals set up under the 1919 Act. These are appointed by the Lord Chancellor and are independent of the Ministry of Pensions.

Constitution.-In 1918 the Ministry consisted of the following branches: (I) Finance (including pensions issue office); (2) awards (men); (3) awards (men's widows and dependents); (4) awards (officers and officers' widows and dependents, and medical treatment and training of officers); (5) local administration; (6) medical services; (7) vocational training; (8) artificial limbs; (9) surgical appliances; (to) chief inspector; (I I) special grants committee. The only important change in these divisions has been in the case of vocational training, which in 1919 was transferred to the Ministry of Labour (save for convalescent centres associated with medical treatment).

In April 1919 a scheme of regional decentralization was begun, and during the following 12 months I i regions were set up. Each is governed by a director, assisted by a commissioner of medical services, a regional administration officer, an awards officer, a finance officer, a registrar, and staff. These regional offices carry on (I) medical examination; (2) awards of pensions; (3) control of Ministry hospitals; (4) supervision of the local war pensions committees.

The Ministry itself, whose staff had numbered at its inception in 1917 2,296, expanded with its work to 5,754 in its first year, and in 1921 had reached 26,000, which included 8,000 hospital staff. (Of the male staff at this date 94% were ex-service men.) The local war pensions committees then numbered 349, with nearly 1,000 subcommittees. They had 27,500 members and a paid staff of 6,200 in addition to many voluntary workers. Space precludes more than a mention of the special grants committee, the chief function of which is to make supplementary and special grants where need exists, under regulations approved by the Ministry of Pensions.

Duties.-The machinery was great, but the burden was gigantic. By 1917 (when the Ministry came into being) 262,000 pensions in all had been granted. The number was doubled in the following 12 months. The increase continued rapidly; at one time as many as 35, 000 new awards were made in a week. The pressure was greatest in the first six months of 1919, when demobilization was at its height. It was estimated at the beginning of 1921 that the crest of the curve had been reached; cessation or reduction of temporary pensions had begun to balance new awards, and medical treatment to be commensurate with the demand.

The subjoined figures have been taken as exemplifying the business of State pensioning at its maximum. (The figures are approximate and are taken from the estimates for 1920-I.) Cost of administration 1920-I, including medi cal services, and local war pensions committees .

up as follows :-

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Disabled men

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1,216,000  
  
Widows

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226,000  
  
Dependents .

Children .

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38423,000000

,  
  
Disabled men .

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I,180,000  
  
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Widows

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169,000  
  
Dependents .

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362,000  
  
Children. .. .

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... 16,900  
  
Officers .

Officers' widows

Officers' children

Officers' other dependents

Nurses .

Nurses' dependents

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56,487

10,408

11,302

7,077

2,045

22  
  
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Officers. .

Officers' widows .

Officers' children .

Officers' other dependents

Nurses. .

Nurses' dependents

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38,850

9,700

9,100

6,500

1,458

22  
  
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Cost of local war pensions committees (admin istration). .. ... £ I, 150,000 Money disbursed through local war pensions committees 1920-I (recoverable advances, treatment allowances, etc.) £ 20,000,000 Estimated total cost of pensions including medical services and administration ex £123,000,000 penses From these sums were treated or maintained, partially or wholly, both the World War and pre-war disability pensioners (the awards of these last by the Royal Warrant of 1917 had been levelled up to the corresponding war scale). The total number of awards had increased from 262,000 in 1917 to 1,849,000 at Dec. 31 1920, made The pensions, temporary and permanent, actually in payment on Dec. 31 1920 were In addition the following first awards of disability retired pay or pension had been made: In payment on Dec. 31 1920 (approx.): Including wives' allowances, and children's allowances the total number of beneficiaries was nearly 3,500,000.

Medical treatment was being carried on in 84 hospitals and convalescent centres and 150 clinics. The Ministry controlled 14,000 beds in its own institutions and 10,000 in civil institutions (cf. the whole voluntary hospital system of the country, which has not more than 40-50,000 beds). There were under treatment at any given time 158,000 cases. The cost of this, including allowances to men under treatment, in excess of pension, amounted to £16,000,000 per annum. The doctors directly employed were 464, the hospital staff numbered 7,600; in addition, for assessment purposes, there were 45 0 medical boards, each of three members, examining over a considerable period from 21,000 to 25,000 men every week.

Special Features.-In addition to the mere mass of the task, many most baffling problems demanded solution. The Ministry, in addition to pensions work and medical treatment, had for example to undertake the supply and repair of artificial limbs and surgical appliances (a special division of the Ministry was organized to deal with this). There were in Dec. 1920 23,932 officers and men pensioned on account of amputations of the leg, and some 64,000 cases of wounds of the upper extremity involving amputation of arm or part of the hand. There were 8,000 cases of epilepsy, 114,000 cases of "heart disease" and 69,000 cases of nervous disease (under which are included both "shell shock" and "neurasthenia").

There was no medical staff in existence to cope with such numbers. In the case of the "nervous diseases" a special training school for psycho-therapy and other forms of treatment was established in London, where a four months' course was given. The problem of "heart disease" demanded specialist attention; a system of special cardiological boards and clinics for examination and diagnosis was started in London, and extended throughout the country.

For the concurrent treatment and training of the broken men six large centres had been opened by Jan. 1921, and it was intended to open two more, giving accommodation in all to between 3,000 and 4,000. The effects of concurrent treatment and training upon the health and prospects of the patients were extremely beneficial. Difficulties were experienced in their absorption in industry, and efforts were made to overcome this by the institution of a national Roll of Honour by which firms pledged themselves to employ a certain proportion of disabled men, while special treatment for the permanently unfit was being considered. (W. E. EL.)